Privacy Practices

As part of its operations, Teamsters Joint Council No. 83 of Virginia Health and Welfare Fund (the group health plan, hereinafter referred to as “the Fund”) creates or receives certain information about you relating to your physical or mental health, the provision of health care to you, and the past, present, or future payments for the provision of health care to you.  The privacy practices and procedures set out herein often refer to “protected health information”.  Protected health information is information that is identifiable to an individual. 

Teamsters Joint Council No. 83 of Virginia Health and Welfare Fund (the group health plan, hereinafter referred to as “the Fund”) is required by law to maintain the privacy of your health information and to provide you with this Notice of its legal duties and privacy practices with respect to protected health information.

The Fund protects your information from inappropriate use or disclosure.  Our employees, and those of companies that provide certain services on our behalf, are required to comply with our requirements that protect the confidentiality of your protected health information.  They may use or disclose your information only as permitted, such as to administer claims.

We will not use your information, or disclose your information to other companies for marketing or fundraising.  However, we will use or disclose your information to another company or person for other reasons required or permitted by law.  The following provisions describe how we may lawfully use or disclose your protected health information.

I.          Uses and disclosures of your protected health information

A.      Treatment, payment or health care operations

The Fund is permitted to use and disclose your protected health information for the following treatment, payment or health care operations, or to the Board of Trustees, as follows:

(1)        Treatment.  The Fund may make disclosures of your protected health information to a health care provider for the health care provider’s treatment purposes.  For example, we may disclose the identity of an individual seeking approval of the drug Retin-A if over 26 years of age to ensure that it is not prescribed for cosmetic reasons.

(2)        Payment.  The Fund may use or disclose protected health information to any person or entity for the purposes of carrying out the Fund’s payment activities.  The Fund receives or discloses your health information to doctors or other health care providers, other insurance carriers and occasionally other third parties for payment purposes.  For example, the Fund receives information from your doctor’s office about your visit to the office and the diagnosis in order to make payment to the doctor on your behalf.  The Fund may also disclose your information to a health care provider, another health plan, or health care clearinghouse for the payment activities of the entity that receives the information.  We may disclose your information to another health plan, for example, for the purpose of coordinating their benefits and our benefits.

(3)        Health Care Operations.  The Fund may disclose your protected health information for its health care operations.  Health care operations include underwriting, contribution establishment and other activities relating to health insurance, arranging for legal services and compliance programs, business planning and business management.  For example, as part of the Fund’s health care operations, it may receive information from its care management company about an inpatient hospital stay.  The Fund may also disclose protected health information to another health plan, health care clearinghouse or health care provider for the health care operations activities of the entity that receives the information, if both the Fund and the other entity either has or had a relationship with you, the protected health information pertains to such relationship, and the disclosure is:

•  For purpose of conducting quality assessment and improvement activities.

•  For the purpose of health care fraud and abuse detection or compliance.

(4)        Board of Trustees.  The Fund may disclose your protected health information to the Board of Trustees (the plan sponsor) in order to manage and administer the Fund, including for payment and health care operations purposes.  For example, the Board of Trustees participates in underwriting, contribution establishment, arranging for legal services and auditing, business planning, conducting cost-management and planning related analyses for managing and operating the entity, including formulary development and administration, development or improvement of methods of payment or coverage policies.  The Board of Trustees has certified that it will not use or disclose your protected health information other than as provided for in the Plan Documents or as required by law.  The certification is included in the Plan Documents.

B.    Other uses and disclosures required or permitted by law

(1)        Secretary of Health and Human Services.  The Fund will disclose your protected health information when required to do so by the Secretary of Health and Human Services or any other officer or employee of HHS to whom the authority involved has been delegated. 

(2)        Communications With You and Your Family.  The Fund may disclose your information to you, or to your family members or close friends.  If you are available, the Fund will ask for your oral agreement before it discloses information to family or friends, or, if you are unavailable, it will exercise its professional judgment in deciding whether it is in your best interests to discuss your information with family or friends.  The Fund will only disclose information to family or friends to the extent of their involvement with your care.

(3)        Disclosures Required by Other Law.  The Fund may use or disclose your protected health information to the extent that such use or disclosure is required by law.  For example, we may disclose your information in the course of a worker’s compensation claim in which you are involved.   

(4)        Incidental Uses or Disclosures.  The Fund may use or disclose protected health information as incident to a use or disclosure otherwise permitted or required by the HIPAA Privacy Standards.

(5)        De-Identified Information.  The Fund may use protected health information to create information that is not individually identifiable health information or to create information that is only identifiable in a limited way, or it may disclose protected health information only to a business associate for such purposes, whether or not such information is to be used by the Fund.  If the information is identifiable in a limited way, such limited information will only be used for the purpose of research, public health, or health care operations. 

(6)        Business Associates.  The Fund may disclose your protected health information to a business associate (such as the Fund’s actuary, pharmacy benefit manager, and others) and may allow a business associate to create or receive your protected health information on its behalf, if the Fund has satisfactory assurance that the business associate will appropriately safeguard the information.

(7)        Disclosures to Law Enforcement Officials.  The Fund may disclose your information to a law enforcement official under the following circumstances:

•  in response to a court order

•  as evidence of criminal conduct

•  for the purpose of identifying or locating a suspect, fugitive, material witness, or missing person

•  if you are a victim of crime (if possible, the Fund will obtain your permission to use or disclose your information)

•  in compliance with laws requiring reporting of certain types of wounds or physical injuries

(8)        Judicial or Administrative Proceedings.  The Fund may also disclose information in the course of any judicial or administrative proceedings so long as it has satisfactory assurance that you have notice that your information is being sought.

(9)        Deceased Individuals.  The Fund will protect your information even after you are deceased.  The Fund may disclose your protected health information to a coroner or medical examiner, funeral director, or to an organ procurement organization in the event of your death 

(10)      Serious Threat to Health or Safety.  The Fund may use or disclose your protected health information, if the Fund, in good faith, believes the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public and the disclosure is to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat, or is necessary for law enforcement authorities to identify or apprehend you.  The Fund may not disclose your information if they learn about the threat to health or safety through a request by you to initiate or to be referred for treatment, counseling, or therapy.

(11)      Military.  The Fund may use and disclose your protected health information if you are Armed Forces personnel or foreign military personnel for activities deemed necessary by appropriate military command authorities as published by notice in the Federal Register. 

(12)      National Security and Heads of State.  The Fund may disclose your protected health information to authorized federal officials for the conduct of lawful intelligence, counterintelligence, and other national security activities authorized by the National Security Act (50 U.S.C. 401 et seq.) and implementing authority (e.g., Executive Order 12333) and to authorized federal officials for the provision of protective services to the President or other persons authorized by 18 U.S.C. 3056, or to foreign heads of state or other persons authorized by 22 U.S.C. 2709(a)(3), or for the conduct of investigations authorized by 18 U.S.C. 871 and 879. 

(13)     Correctional Institutions and Inmates.  The Fund may disclose your protected health information to a correctional institution or a law enforcement official having lawful custody of you, if the correctional institution or such law enforcement official represents that such protected health information is necessary for the provision of health care to you, the health and safety of you or other inmates, or the health and safety of the officers or employees involved with you while in lawful custody.

(14)      Disaster Relief.  The Fund may disclose your protected health information to a public or private entity authorized by law or by its charter to assist in disaster relief efforts.  If you are present for, or otherwise available prior to, a use or disclosure for disaster relief and it does not interfere with the ability to respond to emergency situations, the Fund will give you the opportunity to agree or object to the use of your information.

(15)      Public Health and Other Government Authorities.  The Fund may disclose your health information to proper public health authorities and other government authorities in the following circumstances:

•  a member of the Fund’s workforce or a business associate may make a disclosure of protected health information to report unlawful conduct by the Fund

•  for reports of child abuse or neglect

•  if the Fund believes you to be a victim of domestic violence (if appropriate, the Fund will notify you before it reports this information).

•  for public health activities or health oversight activities such as those regarding an FDA regulated product, or for the oversight of government benefit programs, such as Medicare.  

II.         Your rights

(1)        Inspect and Copy.  You have the right to inspect and copy protected health information about yourself in a designated record set, except for psychotherapy notes or information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative proceeding.  The request for access to copy or inspect must be in writing.  The Fund must act on a request for access no later than 30 days after receipt of the request (or 60 days if the information is kept off-site).  If we deny your request, we will provide information on your review rights and other information.  If you agree in advance, the Fund may respond to your request by providing you a summary of the health information requested.  If you request a copy of your protected health information or agree to a summary or explanation of such information, the Fund may impose a reasonable, cost-based fee to include the cost of copying (and labor), postage when you have requested the copies or summary or explanation be mailed, and the cost of preparing an explanation or summary of the protected health information.  If the Fund does not maintain the protected health information that is the subject of your request for access, and the Fund knows where the requested information is maintained, the Fund will inform you where to direct the request for access.  All requests should be addressed to the Privacy Officer at the Fund Office.  The address is located on the last page of this Notice.

(2)        Amendment.  You have the right to amend your protected health information if you make the request in writing and provide a reason to support a requested amendment.  The Fund must act on your request no later than 60 days after receipt of such request by either amending the information or denying your request for amendment.  If the Fund amends the information as you request, it will forward the amended information to persons or entities it knows have the protected health information and that may have relied on such information to your detriment.  The Fund may deny your request if it determines that the protected health information or record that is the subject of your request (i) was not created by the Fund, unless you provide a reasonable basis to believe that the originator of protected health information is no longer available to act on the requested amendment; (ii) is not part of the designated record set; (iii) would not be available for inspection or copying under the provisions set out in paragraph (1) Inspect and Copy above; or (iv) is accurate and complete.  If the Fund denies your requested amendment, in whole or in part, it will provide you  with a written denial containing the basis for the denial and an explanation about your rights to disagree with the denial.  All requests must be in writing and should be addressed to the Privacy Officer at the Fund Office.  The address is located on the last page of this Notice.

(3)        Accounting.  You have the right to receive an accounting of disclosures of protected health information made by the Fund within the previous six years prior to the date on which the accounting is requested.  You do not have the right to accounting of disclosures made (i) to carry out treatment, payment and health care operations, (ii) to you, (iii) incident to a use or disclosure otherwise permitted or required by this Notice or the HIPAA Privacy Rule (45 C.F.R. Parts 160 and 164), (iv) pursuant to an authorization, (v) to persons involved in your care, (vi) for national security or intelligence purposes, (vii) to correctional institutions or law enforcement officials, (viii) as part of a limited data set in accordance, or (ix) that occurred prior to April 14, 2003.  The Fund will act on your request for an accounting no later than 60 days after receipt of such a request.  The Fund will provide the first accounting to you in any 12 month period without charge.  The Fund may impose a reasonable, cost-based fee for each subsequent request for an accounting within the 12 month period.  We will inform you in advance of the fee and provide you an opportunity to withdraw or modify the request for a subsequent accounting in order to avoid or reduce the fee.  Your requests for an accounting must be in writing and should be addressed to the Privacy Officer at the Fund Office.  The address is located on the last page of this Notice.

 (4)       Restrictions.  You have the right to request restrictions on certain uses and disclosures of your health information when the Fund uses or discloses protected health information to carry out payment or health care operations or when the Fund discloses protected health information to your family members and friends involved in your care. The Fund is not required to agree to your request.  However, if the Fund agrees to a restriction, it may not use or disclose information in violation of such restriction, unless you are in need of emergency treatment and the restricted protected health information is needed to provide the emergency treatment.  Once the Fund has agreed to a restriction, it may only terminate its agreement to a restriction if:

•  You agree to or request the termination in writing

•  You orally agree to the termination and the Fund documents your agreement, or

•  The Fund informs you that it is terminating its agreement to a restriction.  Such termination is only effective with respect to health information received after it has so informed you.

You also have the right to receive confidential communications of your health information upon request.  The Fund must accommodate your requests to receive confidential communications, if you clearly state that the disclosure of all or part of your information could endanger you.  Furthermore, you must provide information as to how payment, if any, will be handled, and you must specify an alternative address or other method of contact.  You should address your requests in writing to the Privacy Officer at the Fund Office.  The address is located on the last page of this Notice.

(5)        Notice of Privacy Practices.  You have the right to obtain a paper copy of the Fund’s Notice of Privacy Practices upon request, even if you have agreed to receive the Notice electronically.           

III.        Other information

(1)        Authorizations.  Except for the uses and disclosures described in Sections A. and B. above, or as otherwise permitted by law, the Fund will make no uses or disclosures of your protected health information unless you have given your written authorization to the Fund permitting it to use or disclose the information.  Furthermore, you may revoke the written authorization given to the Fund at any time, provided that the revocation is also in writing.  There are certain circumstances under which you may not revoke the written authorization.  Those circumstances are

•  If the Fund has taken action in reliance on the authorization; or

•  If the authorization was obtained as a condition of your obtaining insurance coverage, and other law provides the Fund with the right to contest a claim under the policy or the policy itself.

(2)        Complaints.  If you believe your privacy rights have been violated you may file a complaint with the Privacy Officer at the Fund, or you may file a complaint with the Secretary of Health and Human Services.  The address and phone number for the Privacy Officer are located below.  You will not be retaliated against for filing such a complaint.

(3)        Reservation of Rights.  The Fund is required to abide by the terms of the Notice currently in effect.  The Fund reserves its right to change the terms of its Notice and to make the new Notice provision effective for all protected health information that it maintains prior to issuing a revised Notice. The Board of Trustees further reserves the right to modify this Notice in accordance with its practices and policies at any time.  

The Fund will provide individuals with any revised Notice by mail.

(4)        How to Contact Us.  If you wish to exercise any of your rights, or if you have any other questions or complaints about our privacy practices, please contact the Privacy Officer, Teamsters Joint Council No. 83 of Virginia Health and Welfare Fund, 8814 Fargo Road, Suite 200, Richmond, Virginia 23229, (804) 282-3131.